Caries Management Strategies for Primary Molars

Abstract

Minimal invasive approaches to managing caries, such as partial caries removal techniques, are showing increasing evidence of improved outcomes over the conventional complete caries removal. There is also increasing interest in techniques where no caries is removed. We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars: conventional restorations (CR; complete caries removal and compomer restoration), Hall technique (HT; no caries removal, sealing in with stainless steel crowns), and nonrestorative caries treatment (NRCT; no caries removal, opening up the cavity, teaching brushing and fluoride application). In sum, 169 children (3-8 yr old; mean, 5.56 ± 1.45 yr) were enrolled in this secondary care-based, 3-arm, parallelgroup, randomized clinical trial. Treatments were carried out by specialist pediatric dentists or postgraduate trainees. One lesion per child received CR, HT, or NRCT. Outcome measures were clinical failure rates, grouped as minor failure (restoration loss/ need for replacement, reversible pulpitis, caries progression, etc.) and major failure (irreversible pulpitis, abscess, etc.). There were 148 children (87.6%) with a minimum follow-up of 11 mo (mean, 12.23 ± 0.98 mo). Twenty teeth were recorded as having at least 1 minor failure: NRCT, n = 8 (5%); CR, n = 11 (7%); HT, n = 1 (1%) (p = .002, 95% CI = 0.001 to 0.003). Only the comparison between NRCT and CR showed no significant difference (p = .79, 95% CI = 0.78 to 0.80). Nine (6%) experienced at least 1 major failure: NRCT, n = 4 (2%); CR, n = 5 (3%); HT, n = 0 (0%) (p = .002, 95% CI = 0.001 to 0.003). Individual comparison of NRCT and CR showed no statistically significant difference in major failures (p = .75, 95% CI = 0.73 to 0.76). Success and failure rates were not significantly affected by pediatric dentists' level of experience (p = .13, 95% CI = 0.12 to 0.14). The HT was significantly more successful clinically than NRCT and CR after 1 yr, while pairwise analyses showed comparable results for treatment success between NRCT and CR (ClinicalTrials.gov NCT01797458).

Strategies for control and treatment of carious lesions in deciduous molars: a review of the literature

“…After sealing the cavity, the number of microorganisms may reach levels normally found in cavities where all decayed tissue has been removed, in accordance with the criteria of hardness and resistance to tissue removal 25 . techniques are limited, which leaves clinicians uncertain as to their applicability within pediatric dental care 11 . In light of the topic's importance, current strategies for controlling and treating carious lesions in deciduous molars, with regard to procedures and their benefits and limitations, will be presented.…”

“…After selecting the correct size of steel crown and under relative isolation using a cotton roll and saliva ejector, the crown is cemented to the tooth, preferably with glass ionomer cement, without removal of decayed tissue, preparation of the tooth or local anesthesia [9][10][11] . This technique is mainly indicated for intervention in deciduous molars with incipient lesions or moderate active caries lesions affecting two or more surfaces, with no signs or symptoms of pulp involvement.…”

“…Although it is an effective treatment option, its poor aesthetics may be a barrier to acceptance by children, their parents and even dental surgeons 11 .…”

“…Biological approaches to handling carious lesions in deciduous molars embrace several techniques, the most noteworthy being partial removal of decayed tissue with 3,5 or without reopening the tooth to supplement excavation 2,6 , sealing the carious lesion [7][8] , sealing the cavitated lesion with prefabricated steel crowns, known as the Hall technique [9][10][11][12] and, more recently, ultra-conservative treatment…”

Een omslag in cariësbehandeling bij kinderen: ‘Gewoon Gaaf’

“…2) . Deze methode is een beproefde ingreep, waardoor de cariës activiteit kan worden teruggedrongen (Mijan et al, 2013;Santamaria et al, 2014). De kans op pijn en/of dreigende irreversibele ontsteking bepalen uiteindelijk of niet-restauratieve caviteitbehandeling wordt toegepast en of het wordt voortgezet .…”